Health Services ResearchUnderstanding Inpatient Cost Variation in Kidney Transplantation: Implications for Payment Reforms
Section snippets
Dataset
Our primary dataset was the 2005-2009 Nationwide Inpatient Sample (NIS) linked to the American Hospital Association (AHA) annual survey. The NIS dataset is maintained by the Agency for Healthcare Research and Quality and is part of the Healthcare Cost and Utilization Project. For each year of the NIS, data on all discharges are available from a 20% sample of approximately 5000 hospitals in 44 states.
Cohort Identification
Using International Classification of Disease, Clinical Modification (ICD-9-CM) procedure codes,
Descriptive Analysis
From 2005 to 2009, 70,027 kidney transplants were performed in the United States. Of these transplants, 8866 DDRT and 5589 LDRT were included in our sample. At the patient level, the unadjusted cost of kidney transplant varied by donor type (DDRT median, $44,893; range, $15,674 to $533,097; LDRT median, $37,133; range, $15,544 to $312,986).
At the hospital level, inpatient costs varied approximately 4-fold for both DDRT and LDRT. The adjusted mean cost of DDRT was $39,843 (median, $39,740;
Comment
In this study, we found substantial variation in the THC for both LDRT and DDRT across transplant centers. Complications, the use of inpatient dialysis or plasmapheresis, length of stay, and high hospital volume were associated with higher costs. However, after adjusting for these and other patient and hospital characteristics, we found the majority of variation in total costs of inpatient kidney transplant care among hospitals still remained unexplained.
Unexplained cost variation may be the
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Variations in hospitals costs for surgical procedures: inefficient care or sick patients?
2017, American Journal of SurgeryCitation Excerpt :Unwanted variations in health care are those provisions not explained by disease, patient preference, or evidence-based practices. Recent reports have suggested that such variations in care may be associated with differences in physician preferences and postoperative outcomes.4,6 As such, policymakers have proposed provider-focused policies, including the implementation of a bundled-payment system, establishment of accountable care organizations (ACOs), and promoting value-based purchasing, as potential means to curtail increasing health care costs.21–23
Editorial Comment
2016, UrologyAuthor Reply
2016, Urology
Financial Disclosure: David C. Miller reports serving as a paid consultant for ArborMetrix. The remaining authors declare that they have no relevant financial interests.
Funding Support: This research was supported by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney (T32 DK 7782-14 to Chandy Ellimoottil).
No funding organization played a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.